Chapter 41: Fluid and Electrolyte Practice Test

Question 1

Fluids & electrolytes help to maintain ______ in body

Answer 1

homeostasis

Question 2

State of equilibrium

Answer 2

homeostasis

Question 3

Chemical reactions dependent on _______

Answer 3

F & E balance

Question 4

Normal water content in an Adult Male is?

Answer 4

60% of TBW

Question 5

Normal water content in an Adult female is?

Answer 5

50-55% of TBW

Question 6

Normal water content in the elderly is?

Answer 6

45-55% of TBW

Question 7

Normal water content in an infant is?

Answer 7

70-80% of TBW

Question 8

What is the solvent in which body salts, nutrients, and wastes are dissolved and transported?

Answer 8

water

Question 9

______ need to be in correct balance for cells to function properly

Answer 9

Electrolytes

Question 10

What are the Primary electrolytes in body

Answer 10

Na+, K+, Ca2+

Other: Cl, Mg, Bicarb (HCO3), Phosphates (PO4), Sulfates (SO4)

Question 11

Name 2 functions of electrolytes

Answer 11

1. substances which split into ions when dissolved in water

2. able to carry an electrical current

Question 12

Has About 40% of total body weight (TBW) &

Maintains cell size & function

Answer 12

Intracellular fluid (ICF)

Question 13

Name 2 body fluid compartments

Answer 13

intracellular fluid and extracellular fluid

Question 14

Name the fluid inside blood (plasma) (5%)

Answer 14

Intravascular fluid

Question 15

ISF (interstitial fluid) includes what components and functions?

Answer 15

lymph, transports O2, nutrients, hormones, & other chemicals between blood & cell cytoplasm

Question 16

The fluid between cells, outside vascular space is?

Answer 16

Interstitial fluid (ISF)

Question 17

The small amount of fluid in GI tract, cerebrospinal fluid, pleural, synovial, & peritoneal fluids

Answer 17

Transcellular space

Question 18

Extracellular fluid contains _____,_______,_____:

Answer 18

intravascular, interstitial and the transcellular space

Question 19

Body shifts fluid to keep osmolality (concentration of dissolved substances) balanced between 3 fluid spaces. What are those spaces?

Answer 19

plasma, interstitial fluid and intracellular fluid

Question 20

Fluids & electrolytes (solutes) constantly shift between compartments by 4 processes. What are they:

Answer 20

Osmosis
Diffusion
Filtration
Active Transport

Question 21

Body tries to keep osmolality balanced in the 3 fluid compartments by?

Answer 21

shifting fluid or solutes

Question 22

Kussmaul respirations 
Changes in LOC 
Disorientation 
Muscle twitching 
Low PH                       
Low HCO3

What acid-base imbalance is this?

Answer 22

Metabolic Acidosis

Question 23

Rapid, shallow respirations
Dyspnea
Muscle weakness
Low pH                         
High CO2

What acid-base imbalance symptoms are these?

Answer 23

Respiratory Acidosis

Question 24

Slow respirations
Restlessness
Diarrhea 
Nausea & Vomiting
Arrhythmias
High PH                       
High HCO3
What acid-base imbalance symptoms are these?

Answer 24

Metabolic Alkalosis

Question 25

``` Deep rapid breathing Seizures Confusion Tingling of Extremities High pH Low CO2 What acid-base imbalance symptoms are these? ```

Answer 25

Respiratory Alkalosis

Question 26

movement of solvent (water) across semi-permeable membrane from area of lower concentration to higher

Answer 26

Osmosis

Question 27

a higher solute concentration pulls fluid into that space

Answer 27

Osmotic pressure

Question 28

Blood has _____________ due to plasma proteins

Answer 28

colloid osmotic pressure AKA oncotic pressure

Question 29

Keeps fluid from leaking out of vascular space

Answer 29

colloid osmotic pressure AKA oncotic pressure

Question 30

_______ is especially important to keep fluid from shifting out of intravascular space

Answer 30

Albumin

Question 31

If pancreas doesn’t produce enough insulin or if body is resistant to using insulin, glucose is not able to diffuse across cell membrane to be utilized. Which disease does this cause?

Answer 31

Diabetes

Question 32

movement of solutes from higher concentration to lower

Answer 32

Diffusion

Question 33

movement of glucose across cell membrane requires carrier molecules which bind to receptors and make the membranes more permeable to glucose

Answer 33

Facilitated diffusion

Question 34

Movement of O2 & CO2 between alveoli & capillaries

Answer 34

diffusion

Question 35

molecules move from area of lower to higher concentration, requires energy

Answer 35

Active transport – | e.g. sodium-potassium pump allows a higher concentration of K+ in ICF & higher concentration of Na+ in ECF

Question 36

______and _____ are processes used to balance osmolality or solute concentration

Answer 36

Diffusion and osmosis

Question 37

_____ is movement of fluid to balance solute concentration

Answer 37

Osmosis

Question 38

____ is movement of both fluid and solutes to equalize solute concentration

Answer 38

Diffusion

Question 39

transfer of water & dissolved substances through membrane from region of high pressure to region of lower pressure.

Answer 39

Filtration – | ex: Occurs in kidney glomerular capillaries & in blood capillaries

Question 40

____ ____ is generally higher on arterial side & lower on venous side of capillaries

Answer 40

Hydrostatic pressure | ex: In CHF, hydrostatic pressure higher on venous side of capillary beds

Question 41

Fluid moves out of vascular space into interstitial space causing what sx?

Answer 41

edema

Question 42

Force within a fluid compartment which includes: Vascular space or tissues

Answer 42

Hydrostatic Pressure

Question 43

Osmotic pressure exerted by proteins, (especially albumin) | Large molecules hold fluid in vascular space

Answer 43

Oncotic Pressure

Question 44

Total milliosmoles of solute per unit of volume of solution mOsm/L Describes fluids outside the body

Answer 44

Osmolarity

Question 45

Osmotic force of solute per unit of wt. of solvent mOsm/kg or mmol/kg Describes fluids inside the body

Answer 45

Osmolality

Question 46

same concentration of particles as plasma

Answer 46

Isotonic -

Question 47

greater concentration of particles than plasma

Answer 47

Hypertonic -

Question 48

lesser concentration of particles than plasma

Answer 48

Hypotonic -

Question 49

What are the 2 primary body fluid compartments?

Answer 49

intracellular and extracellular fluid

Question 50

Fluid & electrolytes shift between compartments via which 4 processes?

Answer 50

Osmosis Diffusion Filtration Active Transport

Question 51

____ transport keeps K+ higher in ICF & Na + higher in ECF

Answer 51

Active

Question 52

Active transport requires energy in the form of _____ _____ to move electrolytes across cell membranes against the concentration gradient

Answer 52

adenosine triphosphate (ATP)

Question 53

fluid shift from vascular space to interstitial space

Answer 53

Edema –

Question 54

A ↓plasma oncotic pressure due to low protein would cause

Answer 54

Renal disorders, liver disease, malnutrition

Question 55

What causes ↑ pressure in the vascular space?

Answer 55

fluid overload, CHF, liver failure, obstruction of venous return, venous insufficiency

Question 56

damage to capillary walls from trauma (e.g. crushing injury), burns, inflammation Plasma proteins leak into interstitial space causes...

Answer 56

↑interstitial oncotic pressure Oncotic pressure R/T protein molecules holds fluid in the vascular space

Question 57

loss of extracellular fluid from the vascular to other body compartments.

Answer 57

Third spacing ex: Occurs with extensive surgical procedures, burns, septic shock, liver disease Ascites in liver disease, severe edema with burns, peritonitis

Question 58

Define Third spacing

Answer 58

Major fluid shift from intravascular to interstitial space. Ex: Occurs with extensive surgical procedures, burns, septic shock, liver disease Ascites in liver disease, severe edema with burns, peritonitis

Question 59

fluid in abdominal intersitial (IS) space

Answer 59

Ascites

Question 60

Problems that may with Third spacing are?

Answer 60

Causes hypovolemia, hypotension, tachycardia, ↓UOP due to insufficient fluid in vascular space During surgical recovery, fluid shifts back into vascular space and can cause fluid overload

Question 61

Beer and soda are _____ fluids

Answer 61

hypertonic

Question 62

Fluid Shift from Interstitial | Space to Plasma (vascular space) is caused by?

Answer 62

Caused by increase in plasma osmotic or oncotic pressure R/T: Administration of colloids (blood products), dextran, mannitol, or hypertonic solutions

Question 63

Major illness or injuries may result in _____ and ______ _____.

Answer 63

F & E imbalance

Question 64

___ ____ ____ regulated by intake, output, & hormonal controls

Answer 64

Body fluid volume

Question 65

Thirst control center in ____ stimulated when serum osmolality increases

Answer 65

hypothalmus

Question 66

Regulation of Fluid Input values per day are?

Answer 66

``` Need ~ 2200-2700ml fluid input per day 1500+ from fluids 1000 from solid food 300 from metabolism 2800+ mL TOTAL ```

Question 67

Sweat regulated by ?

Answer 67

sympathetic nervous system

Question 68

Fluid output primarily through ?

Answer 68

kidneys

Question 69

Insensible (not noticeable) loss occurs through ?

Answer 69

skin, lungs, GI tract Note: Insensible loss ↑ w/ fever or burns GI tract loses additional fluid through vomiting or diarrhea, use of laxatives and stool softners

Question 70

What would a nurse Assess for Fluid Balance?

Answer 70

``` History Vital signs I&O balance Weight Skin turgor/moisture Mucous membranes Lung sounds JVD Edema LOC Labs ```

Question 71

1 Liter H20 =

Answer 71

2.2 lb or 1 kg

Question 72

who are at HIGH risk for fluid imbalances?

Answer 72

infants elderly- impaired thirst mechanism →dehydration & ↑Na ↑ risk of FVE Post-op and/or NPO anyone Vomiting / Diarrhea Diuretics Chronic Disease- renal,cardiac, endocrine

Question 73

what labs would be assessed for fluid imbalances?

Answer 73

``` H&H: Hemoglobin (Hgb) & Hematocrit (HCT) Electrolytes BUN Urine specific gravity concentrated (>1.025) dilute (<1.01) Serum Osmolality - FYI 275-295 mOsm/kg not a routine lab BNP Electrolytes & BUN will appear more concentrated if someone is dehydrated or hypovolemic ```

Question 74

what is the function of BNP = brain natriuretic peptide?

Answer 74

Secreted in response to increase blood volume & blood pressure, which stretch heart tissue. Binds to receptor in nephrons and inhibits reabsorption of Na and water. This value is increased in CHF.

Question 75

What are the Collaborative Goals for Treating | any F & E Imbalance?

Answer 75

Determine underlying cause through physical assessment & diagnostic testing Correct the underlying cause Replace deficient F & E or remove excess Stabilize pH (acid-base balance)

Question 76

What is the etiology of Hypervolemia, over-hydration

Answer 76

``` Etiology Excessive Na intake (PO or IV) Compromised regulatory systems Renal insufficiency Congestive Heart Failure (CHF) Cirrhosis Endocrine Disorders (SIADH) ```

Question 77

What are the signs and sx of hypervolemia

Answer 77

Signs & Symptoms *Weight gain VS - ↑ BP, ↑ HR, & ↑RR Pulse quality? dyspnea, orthopnea Pitting edema w/ tight, shiny skin JVD @45 degrees Moist crackles cough Headache, agitation, confusion R/T brain cell swelling Labs – blood volume is diluted, what happens? electrolytes, H&H, Urine specific gravity BNP – increased in CHF

Question 78

What is the etiology of AKA Hypovolemia or dehydration (water loss only)

Answer 78

Loss of water and Na Vomiting, diarrhea, diaphoresis, diuretics Hemorrhage, burns cause loss of water, electrolytes, protein, RBCs Decreased intake NPO, anorexia, dysphagia, altered perception of thirst, unable to reach water

Question 79

What are the signs/sx of hypovolemia?

Answer 79

``` Negative balance of intake/output Concentrated urine, ↑specific gravity Weight loss Dry skin/mucous membranes Poor skin turgor, tenting >20-30sec *Weakness, restlessness, confusion Concentrated Hct. & electrolytes Severe FVD → dec. cardiac output, possible shock ```

Question 80

Intracellular fluid is made up of...

Answer 80

Cations (+) – mostly potassium & small amts. of magnesium & sodium Anions (-) – mostly phosphate & protein w/ small amts. chloride & bicarb

Question 81

extracellular fluid is made up of

Answer 81

Cations – mainly sodium w/ small amts of potassium, calcium, & magnesium Anions – mostly chloride, some protein, w/small amts of bicarb, sulfate, & phosphate

Question 82

Sodium Na+ (fyi)

Answer 82

Na+ aids in generation & transmission of nerve impulses and fluid balance Main cation in ECF Range 135-145 mEq/L effects osmolality & water distribution between ECF & ICF Kidneys regulate Na levels by excreting/retaining water Aldosterone promotes Na reabsorption by renal tubules Regulation of Electrolytes SODIUM Plasma Na levels reflect % concentration Abnormal Na levels may indicate water imbalance or sodium imbalance or both Water Excess &/or Hyponatremia (145mEq/L) Treatment depends on cause & fluid status

Question 83

potassium (fyi)

Answer 83

Potassium is major cation in ICF Labs: 3.5-5.0 (slightly higher some places) Potassium needed for conduction of nerve impulses, normal cardiac rhythm, & muscle contraction Potassium must be obtained through diet or supplements drops quickly if not replaced Potassium excreted by kidneys, stool, sweat If kidney function impaired, K+ rises

Question 84

Calcium (fyi)

Answer 84

Ca obtained from food, combined with phosphorus & stored in bone Ca aids in transmission of nerve impulses, myocardial contractions, blood clotting, formation of teeth & bone, muscle contractions Serum Ca levels usually show total of 3 types Ionized (free), bound w/protein (albumin), & complexed w/ phosphate, citrate, or carbonate Ionized is sometimes measured separately – most important in neuromuscular functioning

Question 85

Calcium balance controlled by:

Answer 85

Parathyroid hormone (PTH) Stimulated by low serum Ca levels to move Ca out of bone, ↑GI absorption, & renal tubule reabsorption Calcitonin – Produced by thyroid gland. Responds to ↑Ca. Opposite effects of PTH listed above. Vitamin D – stimulates absorption of Ca from GI tract

Question 86

protein imbalances are:

Answer 86

Plasma proteins (esp. albumin) are indicative of plasma volume Protein increases oncotic pressure and pulls fluid inward into vascular space Causes of imbalance include malnutrition, starvation, fad diets or vegetarian diets w/ insufficient protein, massive burns, liver disease, major infection, loss of albumin in renal disease, hemorrhage S/SX: edema from ↓oncotic pressure, slow healing, anorexia, fatigue, anemia, muscle loss

Question 87

Acid-Base Balance info:

Answer 87

Hydrogen ion concentration in the cellular environment is regulated within extremely narrow limits. This is called acid-base balance For optimum cell functioning, body must maintain acid-base balance Body metabolism produces acids which are buffered by body systems

Question 88

What are the Factors Affecting Fluid, Electrolyte, and Acid-Base Balance?

Answer 88

``` Thirst Vomiting Diarrhea Diaphoresis Diuretic use Stress Chronic illness Renal failure Cardiac failure Respiratory failure Surgery Pregnancy ```

Question 89

What are the sign/sx of Respiratory Acidosis

Answer 89

``` Carbonic acid & PCO2 excess: Anything which causes hypoventilation which leads to ↑CO2 patient cannot catch breath hypoventilation rapid, shallow respirations increase BP dyspnea headache hyperkalemia disorientation muscle weakness hypoxemia low pH below 7.35 high pCO2 above 45 increase cardiac output ```

Question 90

what are the sign/sx of Respiratory Alkalosis?

Answer 90

``` Carbonic acid & CO2 deficit Anything causing hyperventilation or “blowing off” too much CO2; due to respiratory problem or other event pH often corrects self before kidneys need to compensate (would excrete HCO3) seizures deep, rapid breathing hyperventilation confusion hypokalemia lightheadedness tingling of extremities increase pH above 7.45 low PCO2 35 ```

Question 91

what are the sign/sx Metabolic Acidosis?

Answer 91

``` Acids accumulate OR bicarbonate is lost e.g. Ketoacid accumulation in diabetic ketoacidosis or starvation, ASA overdose ↑lactic acid in shock, heavy exercise HCO3 loss in severe diarrhea or renal failure headache disorientation hyperkalemia muscle twitching changes in loc Kussmaul Respirations (compensatory hyperventilation) pH below 7.35 HCO3 below 22 ```

Question 92

what are the sign/sx Metabolic Alkalosis | Base Bicarbonate Excess

Answer 92

``` Occurs w/a loss of acid or gain in bicarbonate prolonged vomiting or gastric suction (lose stomach acid) Excess ingestion of baking soda or IV bicarb restlessness followed by lethargy dysrhythmias diarrhea confusion nausea and vomiting slow respirations hypokalemia increase pH above 7.45 increase HCO3 above 26 compensatory hypoventilation ```

Question 93

What are the signs/sx of Respiratory Compensation:

Answer 93

Lungs control amount of CO2 in blood Consider CO2 an acid (carbonic acid is formed by H20 & CO2) Hyperventilation blows off more CO2 and increases pH to compensate for metabolic acidosis Hypoventilation retains CO2, decreases pH to compensate for metabolic alkalosis

Question 94

What are the signs/sx of Renal Compensation

Answer 94

Renal Compensation: Kidneys help to maintain normal acid-base balance by changing rate of excretion or retention of hydrogen and HCO3 ions. Kidneys are slower than lungs to compensate for sudden changes in acid-base status Kidneys handle increase in blood acids by: Increasing excretion of H+ ions into the urine and returning HCO3 ions to the blood Additional serum bicarbonate is made available to absorb more free H+ ions, and normal pH can be reestablished

Question 95

What do the blood gases mean? (fyi)

Answer 95

ABGs best way to determine acid-base balance pH – hydrogen ion (H+) concentration PaCO2 – partial pressure of CO2 reflects depth & rate of ventilation compensates for metabolic acidosis or alkalosis HCO3- - Bicarb is major renal component of acid-base balance & principle buffer of ECF ECF is 20:1 bicarb to carbonic acid PaO2 – partial pressure of O2 doesn’t affect acid-base if normal Normal 80-100mm Hg If < 60, leads to anaerobic metabolism, lactic acid production, & metabolic acidosis e.g. occurs during cardiac arrest give bicarb as part of resuscitation effort O2 Saturation - Normal 95-99% point at which hemoglobin is saturated by O2 If PaO2<90%, cause for concern

Question 96

how do you determine Respiratory or Metabolic Imbalance?

Answer 96

1.Check pH (normal 7.35-7.45) to determine if patient is acidotic or alkalotic Acidosis 7.45 7.8 = death If full compensation is occurring, pH will be normal 2.Analyze PCO2 & HCO3 to determine if caused by respiratory or metabolic problem (can be both) Normal PCO2 is 35-45mm Hg arterial ↑ = resp. acidosis ↓= resp. alkalosis Normal HCO3 is 22-26mEq/L arterial ↑ = metabolic alkalosis ↓ = metabolic acidosis

Question 97

Define ROME

Answer 97

``` Respiratory Opposite pH high PCO2 low = alkalosis pH low PCO2 high= acidosis Metabolic Equal pH high HCO3 high= alkalosis pH low HCO3 low= acidosis ```